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Sadr AH, Misky AT, Akhavani MA. What happens if you ignore carpal tunnel syndrome? QJM 2021; 114:331-332. [PMID: 32761192 DOI: 10.1093/qjmed/hcaa235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- A H Sadr
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - A T Misky
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - M A Akhavani
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London NW3 2QG, UK
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Sadideen H, Akhavani MA, Mosahebi A, Harris PA. Current perceptions of 'Brazilian butt lift' (BBL) surgery in the UK: A BAAPS-led survey of BAAPS members. J Plast Reconstr Aesthet Surg 2020; 73:1966-1975. [PMID: 32919948 DOI: 10.1016/j.bjps.2020.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/28/2020] [Accepted: 08/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The BAAPS advice against Brazilian butt lift (BBL) surgery in the UK was set in October 2018. A Delphi study conducted by BAAPS highlighted the importance of defining current practice and perceptions amongst UK surgeons, as this is currently unknown. OBJECTIVES To evaluate BAAPS members' current practice and perceptions around BBL surgery to ensure patient safety and propose better recommendations. METHODS A BAAPS-commissioned survey was emailed to all BAAPS members through an on-line link. The survey collected quantitative and qualitative information in several domains. RESULTS This survey received a 44% response rate. Of 102 respondents, 32 surgeons undertook BBL surgery before the BAAPS advice to halt it. There was a wide variation in actual fat volumes injected, and in perceptions of what constituted a small or large volume. Virtually all respondents (96.9%) performed only subcutaneous fat injections. There were differences in fat harvest techniques. The majority (66.7%) felt that BAAPS should maintain its recommendation against undertaking BBL surgery until further data became available. Nearly a quarter of 102 respondents (20.6%) had been treated for BBL complications, the majority as a result of surgical tourism. CONCLUSIONS The survey provides member-reported perception and experience with regard to BBL surgery in the UK. The demand for BBL surgery and its provision should be reassessed in the UK. This information will be analysed with further national and international data to better define and shape the scope of the safety of BBL surgery in the UK. BAAPS will use such data towards the production of future guidance and support for surgeons and patients.
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Affiliation(s)
- H Sadideen
- Cadogan Clinic, 120 Sloane Street, London,UK; Department of Surgery and Cancer, Imperial College London, London, UK.
| | - M A Akhavani
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - A Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, London, UK
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Langridge B, Griffin MF, Akhavani MA, Butler PE. Long-Term Outcomes following Pediatric Peripheral Nerve Injury Repair. J Hand Microsurg 2020; 12:27-31. [PMID: 32280178 DOI: 10.1055/s-0039-1692928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction Peripheral nerve injuries in children are uncommon and can be challenging to diagnose. There is a paucity of data on long-term sensorimotor and functional outcomes following surgical repair. We present a 12-year retrospective analysis of pediatric peripheral nerve repair with long-term functional outcomes. Materials and Methods We performed a retrospective analysis of pediatric patients with peripheral nerve injury requiring surgical repair. Clinical records were analyzed for procedure type, time to surgery, mechanism of injury, postoperative recovery, and complications. Results A total of 108 patients were identified and 87 patients were included. Out of 87 patients, 83 (95.4%) had partial or complete sensorimotor recovery at final follow-up and 4 did not improve. Minor complications occurred in 10.3% of patients, all resolved with conservative management. Mechanisms of injury were predominantly lacerations with sharp objects or crush injuries. Age at time of injury was inversely correlated with sensorimotor recovery, and time to surgical repair was not. Conclusion Surgical repair with long-term hand therapy results in excellent functional outcomes following pediatric peripheral nerve injury. A low threshold for exploration and repair should be used in instances of diagnostic uncertainty. Timing of surgical repair is dependent on a patient's clinical presentation; however, repair within 48 hours is sufficient for optimal sensorimotor recovery.
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Affiliation(s)
- Benjamin Langridge
- Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
| | - Michelle F Griffin
- Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom.,Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.,Division of Surgery & Interventional Science, University College London, London, United Kingdom
| | - M A Akhavani
- Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
| | - Peter E Butler
- Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom.,Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.,Division of Surgery & Interventional Science, University College London, London, United Kingdom
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Abstract
Although much has been published about the treatment of Dupuytren's disease, there is no clear consensus regarding the most effective form of treatment. Part of this uncertainty may result from the absence of a universal method of assessing this condition. We undertook a review of the literature in order to summarize the various methods by which Dupuytren's disease has been measured and quantified. We included all articles that offered a classification or assessment system for the disease. We excluded articles that dealt solely with surgical technique (although inevitably there was some overlap). We conclude that there are many methods of assessment, but that none of them is perfect and that further work is needed in the field.
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Affiliation(s)
| | - A McMurtrie
- Salford Royal Hospital NHS Trust, Salford, UK
| | - M Webb
- Salford Royal Hospital NHS Trust, Salford, UK
| | - L Muir
- Salford Royal Hospital NHS Trust, Salford, UK
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Akhavani MA, Paleolog EM, Kang N. Muscle hypoxia in rheumatoid hands: does it play a role in ulnar drift? J Hand Surg Am 2011; 36:677-85. [PMID: 21463729 DOI: 10.1016/j.jhsa.2011.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 01/23/2011] [Accepted: 01/24/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The cause of ulnar drift in patients with rheumatoid arthritis (RA) is unknown. It may occur because of external forces applied to the fingers during normal use. Alternatively, it may arise after changes in the internal forces on the anatomy of the digits owing to alterations in the supporting structures of the joints or their control mechanisms, or both. Intrinsic muscle tightness, which is commonly seen in RA hands, may be the result of adaptive shortening or a direct consequence of RA. Previous studies carried out by our group have shown that joints, tendons, and associated synovium in RA hands are consistently hypoxic. Therefore, we formed the hypothesis that there is a difference in hand/forearm muscle oxygen tension in RA versus non-RA. METHODS We measured tissue oxygen levels in the intrinsic muscles of the hands and forearm muscles of 29 patients with a diagnosis of RA, who were undergoing elective surgery. We measured oxygen levels using a microelectrode technique. A total of 31 patients without RA undergoing elective surgery served as matched controls. RESULTS Our results show that the intrinsic muscles of RA patients are significantly more hypoxic than in non-RA controls. Moreover, there is a trend in the RA group for increasing hypoxia in a radial-to-ulnar direction when comparing the different intrinsic muscle groups. We also demonstrate that forearm and thenar and hypothenar muscles are significantly more hypoxic in RA versus non-RA patients. CONCLUSIONS The intrinsic muscle weakness, intrinsic tightness, and muscle wasting observed in RA may not be due to disuse atrophy resulting from joint disease. From our data, we speculate that these changes may be the result of direct muscular involvement in RA leading to muscle hypoxia.
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Akhavani MA, McKinnell T, Kang NV. Quilting of full thickness grafts in the hand. J Plast Reconstr Aesthet Surg 2009; 63:1534-7. [PMID: 19853545 DOI: 10.1016/j.bjps.2009.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 06/11/2009] [Accepted: 09/06/2009] [Indexed: 10/20/2022]
Abstract
A skin graft is the simplest way to reconstruct an area of skin loss. To improve the chance of successful take, shearing forces and haematoma formation between the bed and the graft must be reduced. To achieve this, many surgeons use a tie-over dressing to secure the graft. However, 'quilting' the graft to the wound bed is an alternative method for securing grafts which may be superior to tie-over dressings. The purpose of this study was to compare the outcome of securing a full thickness graft by tie-over dressing versus quilting in the hand. To do this, we performed a retrospective review of graft-take in a consecutive series of 40 patients undergoing dermofasciectomy for Dupuytren's disease over a five year period. Our results demonstrate no significant difference in graft-take comparing grafts secured with a tie-over dressing or by quilting. Importantly, there were no cases of injury to the tendons or neurovascular structures in those cases where the graft was secured by quilting. Our technique for securing the graft by quilting is less time-consuming compared with a tie-over dressing. Therefore, we no longer use tie-over dressings to secure full-thickness grafts in the hand.
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Akhavani MA, Larsen H, Paleolog E. Circulating endothelial progenitor cells as a link between synovial vascularity and cardiovascular mortality in rheumatoid arthritis. Scand J Rheumatol 2009; 36:83-90. [PMID: 17476612 DOI: 10.1080/03009740701305704] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cardiovascular disease refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). Most Western countries face high and ever-increasing rates of cardiovascular disease. Each year, more Americans are killed by heart disease than by cancer. Diseases of the heart alone cause 30% of all deaths, with other diseases of the cardiovascular system causing substantial further deaths and disability. Indeed, cardiovascular disease is the major cause of death and disability in the USA and most European countries. The development of the vascular systems requires an intricate interplay of molecules such as vascular endothelial growth factor and endothelial progenitor cells. A defective vascular repair/regeneration is thought to be responsible for propagation of atherosclerosis, a key feature of cardiovascular disease. This is partly attributed to a reduction in the circulating endothelial progenitor cells in peripheral blood. Patients with rheumatoid arthritis (RA) have a higher than average incidence of cardiovascular disease in comparison with the general population, with an increased risk of stroke and myocardial infarction, and an increased risk of fatality following myocardial infarction. This review focuses on the current evidence linking the role played by endothelial progenitor cells to the development of cardiovascular disease and why this might relate to the increased risk observed in RA patients.
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Affiliation(s)
- M A Akhavani
- Kennedy Institute of Rheumatology, Faculty of Medicine, Imperial College, London, UK
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Gore SM, Akhavani MA, Kang N, Chana JS. Chest wall reconstruction using a turbocharged chimaeric anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2008; 61:438-41. [PMID: 17392046 DOI: 10.1016/j.bjps.2007.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 01/19/2007] [Indexed: 11/20/2022]
Abstract
Extremely large chest wall defects may result following salvage oncological surgery. Typically these defects involve a large skin defect combined with a variable resected area of underlying muscle and ribs. In situations where the skin defect is very large the use of a large latissimus dorsi flap may require skin grafting to the donor site if a myocutaneous flap is used or to the recipient defect if a muscle-only flap is used. Alternatively a transverse rectus abdominis flap is a second option but in certain cases this may not be available. We describe the use of a free anterolateral thigh flap to reconstruct a chest wall defect and demonstrate the principle of side-to-side stacking of separate skin paddles to achieve skin closure of a massive defect whilst permitting primary closure of the donor site. The principle of turbocharging components of a chimaeric flap is also described.
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Affiliation(s)
- Sinclair M Gore
- Department of Plastic Surgery and the RAFT Institute of Plastic Surgery Research, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN, UK
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Sivakumar B, Akhavani MA, Winlove CP, Taylor PC, Paleolog EM, Kang N. Synovial hypoxia as a cause of tendon rupture in rheumatoid arthritis. J Hand Surg Am 2008; 33:49-58. [PMID: 18261665 DOI: 10.1016/j.jhsa.2007.09.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 09/05/2007] [Accepted: 09/05/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE Hypoxia and angiogenesis are now recognized as being important events in the perpetuation of joint destruction in rheumatoid arthritis (RA). In 50% of patients with RA, however, the disease also involves inflammation of the synovial tissue surrounding the tendons, which is associated with multiple ruptures and poor prognosis for long-term hand function. The aim of this study was to determine whether hypoxia and angiogenesis may also play a role in RA tendon disease. METHODS Matched in vivo synovial oxygen measurements (invasive and encapsulating tenosynovium and joint synovium) were taken intraoperatively using a microelectrode technique in patients having elective hand surgery for RA. Patients having elective hand surgery for indications other than inflammatory synovitis were recruited as controls. In parallel, RA synovial tissue was harvested and stained for vascular endothelial growth factor (VEGF) and hypoxia-inducible factor-2alpha. Tissue was also cultured under either hypoxic (1% O(2)) or normoxic (21% O(2)) conditions to investigate the effect of hypoxia on the expression of VEGF and its soluble receptor, as well as on the key cytokines interleukin (IL)-6, IL-8, IL-10 and the chemokine monocyte chemoattractant protein-1. RESULTS Invasive tenosynovium was observed to be significantly more hypoxic than either noninvasive tenosynovium or joint synovium in the same patients. Furthermore, RA tenosynovium was shown to be more hypoxic than tenosynovium in patients without RA. This hypoxia was accompanied by expression of VEGF and hypoxia-inducible factor-2alpha. Using in vitro joint synovial cell cultures, upregulation of VEGF expression was shown to be a consequence of this in vivo hypoxia. Furthermore, hypoxia downregulated release of monocyte chemoattractant protein-1 and the immunoregulatory cytokine IL-10. CONCLUSIONS These data demonstrate that hypoxia is a feature of rheumatoid tendon disease and differentially regulates angiogenesis and the inflammatory cascade in RA.
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Affiliation(s)
- Branavan Sivakumar
- Kennedy Institute of Rheumatology, Faculty of Medicine, Imperial College London, London, United Kingdom
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Baker RHJ, Akhavani MA, Jallali N. Resuscitation of thermal injuries in the United Kingdom and Ireland. J Plast Reconstr Aesthet Surg 2007; 60:682-5. [PMID: 17485059 DOI: 10.1016/j.bjps.2006.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 09/03/2006] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to examine the consistency of burns resuscitation practice throughout UK and Ireland. Twenty-six Burns Units were identified via the National Burn Bed Bureau and surveyed via a postal questionnaire. Twenty-three units returned a completed questionnaire, covering all of the units treating children and 17 out of 20 units that treat adults. Nearly all of the Burns Units commence fluid resuscitation at 10% total body surface area of burn in children and 15% total body surface area of burn in adults. The estimated resuscitation volume is calculated using the Parkland or the Muir and Barclay formula in 76% and 11% of units, respectively. The most commonly used resuscitation fluid is Hartmann's solution. No unit uses blood as a first line fluid. Resuscitation is discontinued after 24h in 35% of units and after 36 h in 30% of units. Approximately half of the units do not routinely change the type of intravenous fluid administered after the initial period of resuscitation. This survey illustrates that resuscitation of thermally injured patients in UK and Ireland Burns Units is fairly consistent with a shift towards crystalloid resuscitation.
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Affiliation(s)
- R H J Baker
- Department of Plastic Surgery, The Rainsford Mowlem Burns Unit, Mount Vernon Hospital, Rickmansworth Road, Northwood, Middlesex, UK.
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Young SW, Marsh DJ, Akhavani MA, Walker CG, Skinner JA. Attitudes to blood transfusion post arthroplasty surgery in the United Kingdom: a national survey. Int Orthop 2007; 32:325-9. [PMID: 17396259 PMCID: PMC2323427 DOI: 10.1007/s00264-007-0330-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2006] [Revised: 12/20/2006] [Accepted: 12/22/2006] [Indexed: 01/01/2023]
Abstract
Five hundred orthopaedic surgeons and 336 anaesthetists were surveyed to assess current UK attitudes towards transfusion practice following arthroplasty surgery. Seventy-two percent of surgeons and 73% of anaesthetists responded to the survey. In an uncomplicated patient following total hip arthroplasty, 53.2% of surgeons and 63.1% of anaesthetists would transfuse at or below a haemoglobin (Hb) level of 8 g/dL. Surgeons tended to be more aggressive in their attitudes, with a mean transfusion threshold of 8.3 g/dL compared to 7.9 g/dL for anaesthetists (p<0.01), and with 97% of surgeons transfusing two or more units compared to 78% of anaesthetists (p<0.01). This threshold Hb increased if the patient was symptomatic (surgeons 9.3 g/dL, anaesthetists 8.8 g/dL, p<0.05) or was known to have pre-existing ischaemic heart disease (surgeons 9.0 g/dL, anaesthetists 9.2 g/dL, p<0.05). A wide variability in attitudes and practices is demonstrated, and the development and adoption of consensus guidelines needs to be encouraged if efforts to reduce the use of blood products are to succeed.
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Affiliation(s)
- Simon W. Young
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Middlesex, Stanmore, HA7 4LP UK
| | - Daniel J. Marsh
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Middlesex, Stanmore, HA7 4LP UK
| | - Mohammed A. Akhavani
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Middlesex, Stanmore, HA7 4LP UK
| | - Cameron G. Walker
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - John A. Skinner
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Middlesex, Stanmore, HA7 4LP UK
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Norton S, Akhavani MA, Kang N. The 'Hamburger' technique for harvesting cartilage grafts in nipple reconstruction. J Plast Reconstr Aesthet Surg 2007; 60:957-9. [PMID: 17616370 DOI: 10.1016/j.bjps.2005.11.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 11/27/2005] [Indexed: 11/24/2022]
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Akhavani MA, Baker RHJ. Steam inhalation treatment for children. Br J Gen Pract 2005; 55:557. [PMID: 16004753 PMCID: PMC1472796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
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Sanders G, Mercer SJ, Saeb-Parsey K, Akhavani MA, Hosie KB, Lambert AW. Randomized clinical trial of intravenous fluid replacement during bowel preparation for surgery. Br J Surg 2001; 88:1363-5. [PMID: 11578293 DOI: 10.1046/j.0007-1323.2001.01872.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Bowel preparation using purgatives has previously been shown significantly to increase haemoglobin concentration and decrease weight. This prospective randomized study assessed the effects of administering intravenous fluid during bowel preparation. METHODS Patients having bowel preparation with Picolax for colonic procedures were randomized prospectively to receive no intravenous fluid (group 1) or calculated intravenous crystalloid based on body-weight (group 2) during preparation. Physiological, haematological and biochemical variables were measured before and after bowel preparation. RESULTS Forty-one patients were recruited with a median age of 69 (range 29-86) years, 22 in group 1 and 19 in group 2. There was no difference between groups in any of the variables measured before bowel preparation. On completion, there was a significant difference between groups in mean weight loss (P = 0.01), postural change in systolic pressure (P = 0.015) and serum creatinine concentration (P = 0.008). In addition there was a significant fall in erect blood pressure after bowel preparation in group 1 (P = 0.02). The mean urine output in group 1 was 982 ml and in group 2 was 1808 ml (P = 0.004). The faeces weight between groups was not significantly different. CONCLUSION Picolax bowel preparation has a significant dehydrating effect, which can be minimized by administering a simultaneous volume of intravenous fluid (mean 2 litres in this study).
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Affiliation(s)
- G Sanders
- Colorectal Unit, Department of Surgery, Derriford Hospital, Plymouth PL6 8DH, UK
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